Provider Demographics
NPI:1760644496
Name:MOTIVALA, SORIAYA LIZETTE (MD, FAANS)
Entity Type:Individual
Prefix:
First Name:SORIAYA
Middle Name:LIZETTE
Last Name:MOTIVALA
Suffix:
Gender:F
Credentials:MD, FAANS
Other - Prefix:
Other - First Name:SORIAYA
Other - Middle Name:LIZETTE
Other - Last Name:MOTIVALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:501 SEAVIEW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3400
Mailing Address - Country:US
Mailing Address - Phone:718-226-4940
Mailing Address - Fax:718-226-4945
Practice Address - Street 1:501 SEAVIEW AVE STE 201
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3400
Practice Address - Country:US
Practice Address - Phone:718-226-4940
Practice Address - Fax:718-226-4945
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275732-01207T00000X
NY275732207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty